Evaluation of prognostic factors among patients with chronic graft-versus-host disease
Pérez-Simón, José Antonio (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Afram, Gabriel (Karolinska Institutet (Estocolm, Suècia))
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Piñana, José Luis (Institut d'Investigació Biomèdica Sant Pau)
Caballero Velazquez, Teresa (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Ringden, Olle (Karolinska Institutet (Estocolm, Suècia))
Valcárcel, David (Institut d'Investigació Biomèdica Sant Pau)
Caballero, Dolores (Hospital Universitario de Salamanca)
Remberger, Mats (Karolinska Institutet (Estocolm, Suècia))
Paz, Yanira de (Hospital Universitario de Salamanca)
Sierra, Jorge (Institut d'Investigació Biomèdica Sant Pau)
San-Miguel, J (Hospital Universitario de Salamanca)
Hagglund, Hans (Karolinska Institutet (Estocolm, Suècia))
Universitat Autònoma de Barcelona

Data:	2012
Resum:	Background Chronic graft-versus-host disease (cGVHD) is a major complication after allogeneic stem cell transplantation with an adverse effect on both mortality and morbidity. In 2005, the National Institute of Health proposed new criteria for diagnosis and classification of chronic graft-versus-host disease for clinical trials. New sub-categories were recognized such as late onset acute graft-versus-host disease and overlap syndrome. Design and Methods We evaluated the prognostic impact of the new sub-categories as well as the clinical scoring system proposed by the National Institute of Health in a retrospective, multicenter study of 820 patients undergoing allogeneic stem cell transplantation between 2000 and 2006 at 3 different institutions. Patients were retrospectively categorized according to the National Institute of Health criteria from patients' medical histories. Results As far as the new sub-categories are concerned, in univariate analysis diagnosis of overlap syndrome adversely affected the outcome. Also, the number of organs involved for a cut-off value of 4 significantly influenced both cGVHD related mortality and survival. In multivariate analysis, in addition to NIH score, platelet count and performance score at the time of cGVHD diagnosis, plus gut involvement, significantly influenced outcome. These 3 variables allowed us to develop a simple score system which identifies 4 subgroups of patients with 84%, 64%, 43% and 0% overall survival at five years after cGVHD diagnosis (score 0: HR=15. 96 (95% CI: 6. 85-37. 17), P<0. 001; score 1: HR=5. 47 (95% CI: 2. 6-11. 5), P<0. 001; score 2: HR=2. 8 (95% CI: 1. 32-5. 93), P=0. 007). Conclusions In summary, we have identified a powerful and simple tool to discriminate different subgroups of patients in terms of chronic graft-versus-host disease related mortality and survival.
Drets:	Tots els drets reservats.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Haematologica, Vol. 97, Núm. 8 (january 2012) , p. 1187-1195, ISSN 1592-8721

DOI: 10.3324/haematol.2011.055244
PMID: 22371184

9 p, 823.3 KB

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